There is no one-size-fits-all treatment approach to scoliosis because there are several different types of scoliosis a person can develop, and cause is one of the features that classifies a patient’s condition. The way scoliosis develops is also driven by the age of the individual with the condition.
Scoliosis is a complex condition with many different forms. What causes scoliosis will depend on the type: idiopathic, congenital, neuromuscular, degenerative, or traumatic. With scoliosis, the condition’s most prevalent form is classified as ‘idiopathic’, meaning no single known cause.
Scoliosis is often described as a mysterious and complex condition. This is partially because it’s main form has no known cause, despite efforts made to clearly understand its etiology. Let’s start our discussion of scoliosis causation by touching on five important facts about scoliosis causes.
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As scoliosis is such a prevalent condition, its cause has been, and still is, a subject of great debate. As it’s not formally classified as ‘genetic’, but is often referred to as familia, where does it come from? Are people who participate in certain activities more prone to its development than others? Can environmental factors lead to the development of an abnormal spinal curvature?
I wish I had the answers to all of these questions, but unfortunately, they still evade us. Following are five facts that shed some light on why there is not a simple answer to the question of what causes scoliosis.
The vast majority of known diagnosed scoliosis cases are classified as ‘idiopathic’, meaning there is no single known cause; 80 percent of scoliosis cases fall into this category.
An important thing to understand is that just because there is no ‘single’ known cause doesn’t mean there is a complete absence of a cause. Instead, what it means is that the cause isn’t clear or readily apparent and is instead considered ‘multifactorial’.
When an idiopathic condition indicates a multifactorial causation, this means that its onset is considered to be the result of a combination of multiple variables, and these factors can vary from person to person.
Basically, when it comes to scoliosis, it’s impossible to assign a clear causative source to more than one out of every five cases.
As mentioned above, 80 percent of known scoliosis cases are classified as idiopathic, but what makes up the other 20 percent? The other 20 percent consists of types of the condition that develop from a specific known cause.
In typical forms of scoliosis, the curvature will bend to the right, away from the heart; in some atypical forms, such as in the following with known causes, the curvature can bend to the left, and this is a red flag that there is a larger issues causing the scoliosis, such as the presence of another disease.
In these cases, the cause determines the treatment approach as the larger underlying medical issue has to guide the treatment approach.
The types of scoliosis that have been identified to have direct causes are congenital, neuromuscular, traumatic, and degenerative.
Congenital scoliosis develops in utero due to a bone malformation in the spine. This form is relatively rare, affecting approximately 1 in 10,000 newborns.
Congenital scoliosis develops when the bones of the spine (vertebrae) don’t form normally while the baby is in the womb. If you think of the vertebrae as cylindrical in shape and stacked on top of one another, if one is, say, triangular in shape instead, you can imagine how easily this can disrupt the natural alignment of the spine.
When a vertebrae hasn’t formed properly, it can cause a sharp angle, known as a ‘hemivertebrae’ to develop in the spine. There is also another cause where the developing spine doesn’t fully separate into different vertebrae; what can happen instead is two or more vertebrae become partially fused. Some cases are a combination of these issues, and congenital scoliosis can vary in severity from mild to very severe.
The spine, along with other organ systems, forms during the early stage of pregnancy, which is why it’s not uncommon that infants born with congenital scoliosis have other medical issues present such as bladder, kidney, and/or nervous system problems.
When neuromuscular scoliosis (NMS) develops, it does so because there is another underlying medical condition present such as cerebral palsy, muscular dystrophy, or spina bifida; these conditions can affect the body’s neurological system, muscular system, or both.
Cases of neuromuscular scoliosis are challenging to treat as there is a larger medical issue that has to guide the treatment process, and sadly, I typically can’t offer these patients as positive a prognosis as I can with more common forms of scoliosis.
While it’s not automatic that every person with a neuromuscular condition will develop scoliosis, it is quite common, and the progression and severity of NMS is related to the extent of muscle and nerve involvement associated with an individual’s condition.
Traumatic scoliosis develops when a significant trauma has been experienced by the spine and affects it adversely. These most commonly include surgeries, accidents, or other body traumas such as a fall.
The presence of tumors pressing on the spine can also cause enough trauma to force the spine out of alignment.
Degenerative scoliosis commonly affects older individuals. As the body ages, it experiences natural degenerative effects, and the spine is no exception.
Most commonly affecting the intervertebral discs, the cumulative effect of certain lifestyle choices and natural age-related degeneration can weaken the spine, leading to it becoming misaligned and developing an abnormal curvature.
The lifestyle choices known to adversely affect the health of the spine include not maintaining a healthy weight, practicing poor posture, not exercising enough, and repeatedly lifting heavy objects incorrectly and straining the spine.
When the spine and its individual parts, such as the intervertebral discs, are exposed to excess pressure and/or uneven forces, the ability of the spine to maintain its natural and healthy curvatures is compromised, leading to the development of degenerative scoliosis.
Spinal infections are most often caused by bacterial microorganisms, and fungal infections less often.
Spinal infections most often are spread by the microorganism traveling from another infected area of the body.
In most cases of spinal infections that are diagnosed early, patients can be treated effectively and conservatively with antibiotics, bed rest, and scoliosis bracing; in cases where spinal instability is severe and there are neurological deficits, conservative treatment has failed, spinal abscesses have formed, or signs of sepsis are present, surgical treatment can be recommended.
Regardless of whether a treatment response is surgical or nonsurgical, patients with spinal infections have to be monitored closely with frequent neurological exams and X-rays to truly see what’s happening in and around the spine.
In some mild cases, it can be recommended that antibiotics are withheld, but when severe, and/or if signs of sepsis and neurological deficits are present, antibiotics should be started immediately.
Some consider scoliosis to be more of a spinal deformity than a disease.
Disease is defined as an abnormal condition that negatively affects the function and/or structure of a part or system within the body, and diseases aren’t always caused by an injury or external source, with many not having a known cause.
As scoliosis involves the development of an unnatural sideways-bending and twisting spinal curve, it’s a structural spinal condition.
In addition, scoliosis is a progressive structural spinal condition, and it’s progressive because its nature is to get worse over time, so where a scoliosis is when it’s first diagnosed doesn’t mean that’s where it will stay.
Now, most cases of scoliosis are idiopathic: not associated with a single known cause, but scoliosis does have types with known causes such as neuromuscular scoliosis, degenerative scoliosis, and congenital scoliosis.
Whether scoliosis, or certain condition types, are considered more of a disease than a spinal deformity, the most important factor is how a diagnosis of scoliosis is responded to with treatment.
Scoliosis is a structural spinal condition, meaning its underlying nature is a structural abnormality within the spine itself, and this means no change in position can reduce a structural scoliosis.
Now, in cases of nonstructural scoliosis, like postural scoliosis, this is a nonstructural condition not considered a true scoliosis because it’s nonstructural and there is no rotation of the spine present.
In cases of postural scoliosis, bending forward can change the nature of the curve, as can many changes of position because the curve isn’t structural; postural scoliosis is caused by chronic poor posture and can be treated with physical therapy, lifestyle guidance, and condition-specific exercises.
For a true structural scoliosis, treatment is more complex because it has to impact the spine, first and foremost, on a structural level, and conservative treatment works towards this through condition-specific chiropractic care.
Once a condition is impacted on a structural level, the focus of treatment can shift to increasing core strength so the spine’s surrounding muscles can optimally support it, and corrective bracing and rehabilitation are additional facets of treatment.
When in a forward bend position, the spine, its rotation, and any postural symmetries in the trunk are highly visible, which is why an Adam’s forward bend test is known as the gold standard of scoliosis screening examinations.
There are never treatment guarantees, but with scoliosis that’s diagnosed and treated early in the condition’s progressive line, there are fewer limits to what can be achieved.
As so many cases of scoliosis are idiopathic, there has been a significant effort made to determine whether scoliosis can be classified as genetic or not. While genetics can play a role in neuromuscular and congenital scoliosis, a specific genetic link has yet to be identified with idiopathic cases.
In addition to gaining a fuller understanding of scoliosis, I feel part of the motivation behind trying to find a specific ‘scoliosis gene’ is that it would neatly explain the condition’s cause and remove some of the concerns that a person’s actions somehow led to its development.
However, despite the years of research and studies done attempting to isolate a specific gene or genetic mutation to account for the condition’s development, one has yet to be clearly identified. Instead, experts generally agree that scoliosis should be considered ‘familial’, as having a person in the family with scoliosis can be a risk factor for other family members.
So what’s the difference between genetic and familial? I’ve explained what ‘genetic’ means, and when it comes to ‘familial’, this means that while scoliosis can seem to run in families, this could be the result of numerous shared factors because families share a lot more than just their genes: lifestyle, posture, responses to stress, socioeconomic factors, location, etc.
In addition, there have been twin studies done where one twin develops scoliosis while the other doesn’t, or cases where one twin develops a certain curvature pattern, and the other an opposite type.
While it might still be possible that scoliosis does indeed have a genetic basis, there is also no way to predict whether or not that gene will express itself in the carrier. In other words, a person can be carrying a scoliosis gene (if it exists), but never develop the condition, and conversely, a person not carrying the gene can develop scoliosis through a combination of other causative factors.
Back to the condition’s multifactorial nature, it’s important to understand that idiopathic scoliosis almost always develops out of a combination of causes, rather than one specific cause.
While we can’t often trace a patient’s scoliosis back to a clear cause, it does seem clear that most cases of idiopathic scoliosis develop due to a combination of factors, some genetic and some environmental.
To put it plainly, scoliosis is not a simple condition; it’s complex. It affects different people in different ways, and this is why it’s crucial that each and every patient is evaluated independently to help determine the factors that most likely led to the condition’s development and can contribute to how it progresses.
As I stated earlier, it’s difficult to tell patients and their families that I don’t know what caused their scoliosis to develop, but just because a cause is unidentifiable doesn’t mean the condition can’t be treated effectively.
In most cases, by the time a person notices that something is wrong and receives a scoliosis diagnosis, regardless of the cause, the condition has become structural and needs to be treated as such.
While I can’t deny a desire to fully understand the causation behind every patient’s condition, the cause rarely factors into how I approach and implement treatment for typical idiopathic cases.
Here at the Scoliosis Reduction Center, we offer our patients an integrative and functional treatment approach, meaning we combine different treatment disciplines to fully customize treatment plans, and we prioritize the spine’s function as our treatment goal.
We combine scoliosis-specific chiropractic care, in-office therapy, custom-prescribed home exercises, and specialized corrective bracing. We monitor how a patient’s spine is responding to treatment, and we apportion these disciplines accordingly to improve spinal strength and flexibility, while working towards reducing the abnormal curvature on a structural level.
Now that we have touched on five general and important points about scoliosis causes, let’s focus on some specifics of scoliosis development in different age groups, starting with the condition’s most common for: AIS.
The most prevalent form of scoliosis is adolescent idiopathic scoliosis, accounting for 80 percent of known diagnosed scoliosis cases. It’s diagnosed in individuals between the ages of 10 and 18.
Again, the ‘idiopathic’ designation means there is no single known cause and is instead considered to be multifactorial.
Despite not knowing why AIS develops, I do understand what triggers progression and can manage it effectively.
As a progressive condition, scoliosis is going to get worse over time, if left untreated, which is why proactive treatment is so important. Growth is the number-one trigger for progression, and of course, adolescents who are going through, or entering into the stage of puberty, are going to go through rapid and unpredictable growth spurts.
Here at the Scoliosis Reduction Center, we customize each and every treatment plan to address the unique characteristics of the patient and their condition. Our approach is functional and integrative, meaning we combine multiple treatment disciplines and prioritize the spine’s function in our treatment goal.
We monitor how a patient’s spine is responding to treatment and apportion our treatment forms accordingly.
So, again, while we don’t fully understand the cause of AIS, we know how it develops and progresses once it is diagnosed, and we know how to respond proactively in the hopes of achieving a curvature reduction and staying ahead of a patient’s progressive line.
As we have started with the condition’s most prevalent form (AIS), and its idiopathic and progressive nature, let’s move on to how idiopathic scoliosis develops and presents in younger children.
We’ve touched on congenital scoliosis in infants in our ‘known causes’ section, and we’ve explored the main form of scoliosis affecting adolescents, but what about idiopathic scoliosis in young children between the infant and adolescent stage?
While a lot of the discussion around scoliosis development centers around adolescents, and sometimes adults, younger children can develop it too.
Let’s take a closer look at how idiopathic scoliosis development affects young children before they reach the adolescent stage.
Infantile Idiopathic Scoliosis
As we have already discussed the cause of scoliosis development in infants before birth in the form of congenital scoliosis, let’s move on to how idiopathic scoliosis develops in children under the age of 2.
When scoliosis develops in children under the age of 2, this is known as ‘infantile scoliosis’, and when the cause is unknown, it’s further classified as ‘infantile idiopathic scoliosis’.
While scoliosis is rare at this young age, common symptoms include one leg looking longer than the other, the appearance of a rib arch, or a noticeable lean to one side. While some cases of infantile idiopathic scoliosis get better on their own, there is no way of knowing which cases will remedy themselves, and which will progress if left untreated.
Now, let’s move on to how scoliosis develops and affects children between the ages of 3 and 10, known as ‘juvenile early-onset scoliosis’.
Juvenile Early-Onset Scoliosis
Diagnosed between the ages of 3 and 10, juvenile early-onset scoliosis differs from infantile and adolescents forms, even though, technically, they all fall under the umbrella of ‘pediatric scoliosis’.
While the cause of early-onset juvenile scoliosis is, again, unknown, we know that once it develops, it’s much more likely to progress throughout childhood and well into adulthood, if left untreated.
Generally speaking, the patients who have the most growing to do are the ones who are likely to experience the most progression. As mentioned, scoliosis tends to progress during periods of physical growth and development, so the condition has the potential to affect younger people who have not yet reached their first adolescent growth spurt more than older individuals; this is why pediatric scoliosis, and early-onset juvenile scoliosis in particular, should be taken seriously and treated accordingly.
When scoliosis is diagnosed in children prior to their first big growth spurt, the potential for healing and reducing abnormal spinal curvatures has few limits.
If you notice something seems off with a child in your life and you suspect scoliosis might be the cause, don’t hesitate to get the answers you need as early detection can increase chances of treatment success.
While idiopathic scoliosis is far more prevalent amongst adolescents, adults can develop it too, although there is an important distinction to understand in terms of causation.
When an adolescent is diagnosed with AIS, most often, the diagnosis is reached after noticing some related postural changes at home, or indicators are detected during a routine physical.
When an adult is diagnosed with scoliosis, there are two main types: degenerative, which we have already discussed, and idiopathic (the more common of the two forms). When an adult is diagnosed with idiopathic scoliosis, this means they had scoliosis as an adolescent, but were unaware, and the condition progressed into maturity.
So in these types of cases, the adults developed the condition many years before, but it’s likely that it didn’t produce noticeable symptoms, like pain, until skeletal maturity was reached; it’s most often back pain and pain that radiates into the legs and feet that brings adults in to see me for a diagnosis.
While scoliosis in children and adolescents is not often described as painful, adults experience scoliosis-related pain very differently.
As children and adolescents are growing, their spines are constantly going through a lengthening motion, and this counteracts the compressive force of the curvature, known as the main cause of scoliosis-related pain.
Once skeletal maturity has been reached in adulthood, the spine is no longer growing and becomes vulnerable to the compression the abnormal curvature exposes the spine and its surrounding muscles, vessels, and nerves to.
Unfortunately, had these adults received a diagnosis earlier and sought out proactive treatment in their youth, their spines would likely be in far better shape than they are by the time I see them, as their scoliosis has been left to progress unimpeded over the years.
Here at the Scoliosis Reduction Center, my top treatment goal is to preserve the function of the spine and give my patients the best possible quality of life. While no one can fully cure scoliosis because it’s incurable, the condition can most certainly be managed and treated effectively.
Part of the diagnostic process involves classifying a condition based on a number of characteristics such as age of the patient, location of the curvature, condition severity, and cause.
As we have discussed, the majority of scoliosis cases are classified as ‘idiopathic’, meaning there is no known single cause. While 80 percent of scoliosis cases are idiopathic, the remaining 20 percent have known causes and fall into one of the following scoliosis types: congenital, neuromuscular, traumatic, or degenerative.
The important thing to understand is that even in forms with no known cause, scoliosis is treatable and manageable to live with.
Knowing the cause of a condition can be helpful, but once a condition has developed, the best response is moving forward in the most positive and proactive way possible, and this means accepting that causation isn’t always easy to determine, nor would it necessarily alter the chosen course of treatment, or its outcome.